Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India.
01 Nov 2019-The journal of the Intensive Care Society (J Intensive Care Soc)-Vol. 20, Iss: 4, pp 309-315
TL;DR: Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol, and nurses found the system to be useful in providing automated turn reminders and prioritising tasks.
Abstract: PurposeHospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized...
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TL;DR: In this article , the authors explored the impact of movement monitoring devices on risk prediction and prevention of pressure ulcers (PU) among adults using a systematic review methodology, using a prospective design, written in English, assessing adult patients' movement in bed using a movement monitoring device.
Abstract: The present study sought to explore the impact of movement monitoring devices on risk prediction and prevention of pressure ulcers (PU) among adults. Using systematic review methodology, we included original research studies using a prospective design, written in English, assessing adult patients' movement in bed, using a movement monitoring device. The search was conducted in March 2021, using PubMed, CINAHL, Scopus, Cochrane, and EMBASE databases, and returned 1537 records, of which 25 met the inclusion criteria. Data were extracted using a pre‐designed extraction tool and quality appraisal was undertaken using the evidence‐based librarianship (EBL). In total, 19 different movement monitoring devices were used in the studies, using a range of physical sensing principles. The studies focused on quantifying the number and types of movements. In four studies the authors compared the monitoring system with PU risk assessment tools, with a variety of high and low correlations observed. Four studies compared the relationship between movement magnitude and frequency and the development of PUs, with variability in results also identified. Two of these studies showed, as expected, that those who made less movements developed more PU; however, the two studies also unexpectedly found that PUs occurred in both low movers and high movers. In the final two studies, the authors focused on the concordance with recommended repositioning based on the results of the monitoring device. Overall, concordance with repositioning increased with the use of a monitoring device. The synthesis of the literature surrounding bed monitoring technologies for PU risk prediction showed that a range of physical sensors can be used to detect the frequency of movement. Clinical studies showed some correlation between parameters of movement and PU risk/incidence, although the heterogeneity of approaches limits generalisable recommendations.
2 citations
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TL;DR: In this paper , the authors examined the movement profiles of individuals with spinal cord injury (SCI) during their inpatient rehabilitation phase using continuous pressure monitoring (CPM), evaluating the trends in those with skin damage.
Abstract: Cohort observational study.To examine the movement profiles of individuals with spinal cord injury (SCI) during their inpatient rehabilitative phase using continuous pressure monitoring (CPM), evaluating the trends in those with skin damage.SCI specialist rehabilitation centre in the United Kingdom.Individuals with SCI (n = 12) were assessed using CPM in the bed and chair over a 24-72 h. Pressure data was used as a surrogate for movement using both nursing interpretation and an intelligent algorithm. Clinical features were obtained including participants age, injury level, ASIA score, co-morbidities and prescribed support surfaces. Trends between movement profiles (frequency and intervals), SCI demographics and observed skin damage were assessed using cross-tabulation and histograms.The data revealed significant correlations (p < 0.05) between the nursing observation and algorithm for predicting movement, although the algorithm was more sensitive. Individuals with high level injuries (C1-T6) were observed to have a lower frequency of movement and larger intervals between movements when compared to low level injuries (T7-L5) during both lying and sitting periods. The individuals observed to have skin damage were predominantly those who had both a low frequency of movement and extended gaps between movements.Movements for pressure relief in both the bed and chair environments were dependent on the level of injury in individuals with SCI during their inpatient rehabilitation. Distinct movement patterns corresponded with those who acquired skin damage, revealing the potential clinical applications for technologies to monitor PU risk and inform personalised care.
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TL;DR: To analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis, which concludes seven attributes for the repositioned practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time.
Abstract: Introduction Repositioning practice is an essential pressure ulcer prevention intervention that has emerged in the history of nursing. Numerous terms are employed to indicate its meaning, such as turning, positioning, or posturing. However, there is no available analysis that distinguishes these terms or analyzes repositioning practice attributes. Objective To analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis. Concept Description Repositioning practice passes through three eras: classical, modern, and research. The repositioning practice is “turn a bedridden patient in a harmonized way and ends with anchor and documentation.” The analysis concludes seven attributes for the repositioning practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time. The analysis assumes bedridden patients, and assigned nurses on duty are the antecedents. Moreover, the main consequence is pressure ulcer prevention, while patient safety and quality of care are the secondary consequences. Discussion Repositioning practice understanding has grown with time. Each era has added to or removed from nursing's understanding for repositioning practice until it appears as it now. The current analysis expects further development in repositioning practice understanding and applications. Conclusion Repositioning practice is an important nursing intervention and has shown a dynamic movement over history. It is expected that this dynamic will continue in the future.
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01 Jul 2022
TL;DR: The outcome of this study promises a pressure ulcer prevention system, with placing a wearable and multi-use sensor system on more comfortable and various locations on the body for a “patient rotate system”.
Abstract: Pressure ulcers, also called bedsores, occur when the skin is under constant pressure for a long time and is more common in hospitalized patients. To prevent a diminish in quality of daily lives and the additional cost of clinical care, a “patient rotate system” is the standard procedure. Although there are commercial clinical platforms that suggest when and how to rotate a patient lying in bed, some of these platforms are 1) using a wearable system that has one-use accessories which increase the total cost of operation 2) rely on a system-on-a-chip that should be placed on a predetermined location which might not be the most comfortable based on the posture. This study evaluates an alternative by using a simple inertial measurement unit (IMU) hardware inside a self-designed and re-usable (disinfectable) 3d printed case placed on different anatomical regions (sternum, left and right acromion, above talus, below patella) for performance. It is suggested that, based on the regions selected, a “patient rotate system” automation is feasible with more comfortable sensor placements (e.g., on the lower limbs) without statistically significant differences (p<0.05). Clinical Relevance- The outcome of this study promises a pressure ulcer prevention system, with placing a wearable and multi-use sensor system on more comfortable and various locations on the body for a “patient rotate system”.
1 citations
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TL;DR: Through the method, the measured values from the gyroscope-based wearable device did not accurately reflect the patient's actual position, however, the wearable device was able to distinguish the lateral position from the supine position.
Abstract: Background Monitoring patients' position is important, but there have been few studies related to validation. Objective The objective of this study was to assess the validity of position monitoring measured using a wearable device by comparing the device's measurements to a patient's actual position. Methods We constructed a wearable device with a three-axis gyroscope and applied it to 10 patients who were unable to change their position independently. We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot and a receiver operating characteristic curve. Results We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot, but it was difficult to observe statistical similarity. The angles transmitted from the wearable device in the lateral and supine positions showed significant differences. The cutoff value separating the lateral and supine positions was found to be 27.1∘ (sensitivity = 100%, specificity = 99.9%). Conclusions Through our method, the measured values from the gyroscope-based wearable device did not accurately reflect the patient's actual position. However, the wearable device was able to distinguish the lateral position from the supine position.
References
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TL;DR: This paper presents a novel orientation algorithm designed to support a computationally efficient, wearable inertial human motion tracking system for rehabilitation applications, applicable to inertial measurement units (IMUs) consisting of tri-axis gyroscopes and accelerometers, and magnetic angular rate and gravity sensor arrays that also include tri- axis magnetometers.
Abstract: This paper presents a novel orientation algorithm designed to support a computationally efficient, wearable inertial human motion tracking system for rehabilitation applications. It is applicable to inertial measurement units (IMUs) consisting of tri-axis gyroscopes and accelerometers, and magnetic angular rate and gravity (MARG) sensor arrays that also include tri-axis magnetometers. The MARG implementation incorporates magnetic distortion compensation. The algorithm uses a quaternion representation, allowing accelerometer and magnetometer data to be used in an analytically derived and optimised gradient descent algorithm to compute the direction of the gyroscope measurement error as a quaternion derivative. Performance has been evaluated empirically using a commercially available orientation sensor and reference measurements of orientation obtained using an optical measurement system. Performance was also benchmarked against the propriety Kalman-based algorithm of orientation sensor. Results indicate the algorithm achieves levels of accuracy matching that of the Kalman based algorithm; < 0.8° static RMS error, < 1.7° dynamic RMS error. The implications of the low computational load and ability to operate at small sampling rates significantly reduces the hardware and power necessary for wearable inertial movement tracking, enabling the creation of lightweight, inexpensive systems capable of functioning for extended periods of time.
1,482 citations
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TL;DR: The Braden Scale for Predicting Pressure Sore Risk (BSRS) as mentioned in this paper was developed to foster early identification of patients at risk for forming pressure sores by using sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status.
Abstract: The Braden Scale for Predicting Pressure Sore Risk was developed to foster early identification of patients at risk for forming pressure sores. The scale is composed of six subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status. Content and construct validity were established by expert opinion and empirical testing. Three studies of reliability are reported here, using raters who varied in level of educational preparation and geographic region. Two prospective studies of predictive validity were completed to determine the scale's sensitivity and specificity. Reliability ranged from r = .83 to r = .94 for nurses' aides and licensed practical nurses; when used by registered nurses, the reliability increased to r = .99. Predictive validity was calculated for each cut-off point of the scale. Using a cut-off point of 16, sensitivity was 100% in both studies. Specificity ranged from 64% to 90%. This instrument has highly satisfactory reliability when used by RNs, and greater sensitivity and specificity than instruments previously reported.
1,242 citations
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TL;DR: The estimates reported here provide a basis for assessment of the cost-effectiveness of measures to reduce the incidence of hospital-acquired ulcers, both to patients and to health-care providers.
Abstract: Objective: To provide an estimate of the costs of treating pressure ulcers in the UK at August 2011 prices, as a means of highlighting the importance of pressure ulcer prevention. Method: Resource use was derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reflecting good clinical practice, with prices reflecting costs to the health and social care system in the UK. This approach was used to estimate treatment costs per episode of care and per patient for ulcers of different severity and level of complications. Results: The cost of treating a pressure ulcer varies from £1214 (category 1) to £14 108 (category IV). Costs increase with ulcer severity because the time to heal is longer and the incidence of complications is higher in more severe cases. Conclusion: Pressure ulcers represent a significant cost burden in the UK, both to patients and to health-care providers. Without concerted effort, this cost is likely to increase in the future as the populati...
331 citations
"Effectiveness of a continuous patie..." refers background in this paper
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Journal Article•
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TL;DR: The protocol by which predictive instruments can be tested for validity and the usefulness of an instrument for predicting pressure sore risk in an AICU was described and the Braden Scale compared favorably with the Norton Scale in respect to sensitivity.
Abstract: The purpose of this article was to describe the protocol by which predictive instruments can be tested for validity and to evaluate the usefulness of an instrument for predicting pressure sore risk in an AICU. The Braden Scale for Predicting Pressure Sore Risk was described. Methods for measuring predictive validity and for calculating sensitivity, specificity, and per cent predictive value of positive and negative tests were discussed. Sixty consecutively admitted AICU patients who were pressure sore free were rated for pressure sore risk within 24 to 72 hours after admission. The skin condition of each patient was systematically assessed every 2 days. Twenty-four subjects developed pressure sores during the study period. The critical cut-off point at which the patient could be judged to be at risk for pressure sore formation was a Braden Scale score equal to or less than 16. The sensitivity and specificity of the scale at this score were 83 to 64 per cent, respectively. The per cent predictive value of a positive and negative test were 61 and 85 per cent, respectively. The Braden Scale compared favorably with the Norton Scale in respect to sensitivity. The specificity, or the tendency of a scale to overpredict, was greater for the Norton than for the Braden Scale. The Norton Scale overpredicted by 64 per cent, whereas the Braden Scale overpredicted by 36 per cent. This difference may be important clinically if all patients who were judged to be at risk received additional nursing care or protective devices. A greater number of patients may receive unnecessary and expensive treatments using the Norton Scale.
277 citations
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20 May 2011
TL;DR: This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on patterns of utilization and costs for adult hospital stays involving the treatment of pressure ulcers in 2006.
Abstract: This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on patterns of utilization and costs for adult hospital stays involving the treatment of pressure ulcers in 2006. Variation in the characteristics of stays principally for pressure ulcers and hospitalizations with a secondary diagnosis of pressure ulcers are compared to stays for all other conditions. Differences in utilization are illustrated according to patient age, expected primary payer, and related conditions. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.
205 citations
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